Provider Demographics
NPI:1669673240
Name:RALSTON, SYMA ROSE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SYMA
Middle Name:ROSE
Last Name:RALSTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 XAVERIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1636
Mailing Address - Country:US
Mailing Address - Phone:301-565-0622
Mailing Address - Fax:301-565-0622
Practice Address - Street 1:1311 XAVERIA DRIVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1636
Practice Address - Country:US
Practice Address - Phone:301-565-0622
Practice Address - Fax:301-565-0622
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist